Fads in medicine come and go. In lucky cases, the field at large will benefit from the fad, taking from it what was good and what worked and leaving behind that which proved to be wrong. In the grand scheme of things, when there is a fad in medicine the entire population is used as test subjects. When the fad is over, it is quickly forgotten and people move on to the next movement.

Not much was known about women’s health before the 19th century. Really. And much of what was known, wasn’t really known but was assumed based on cultural expectations. In the 19th century, medicine became more specialized. Treatments for female ailments beyond the old, tradition laudinum and port, became more varied and one could shop around. The fields of gynecology and psychology were in their nascent stage, though the borders between the two remained very murky. Early specialists in both fields fought passionately over contested territory, and women’s medicine may as well have been Alsace-Lorraine.

It was commonly assumed throughout much of medical history, that the female reproduction system and the female neurological systems were one and the same, or just so intertwined that there wasn’t much difference. For example, in the medieval period, it was believed that a woman’s womb could wander throughout her body, causing a myriad of afflictions: irregular cycles, sores arms, nervousness, stiff necks, cramped feet, and so forth. The only relief for the “wandering womb” was regular sexual intercourse (with husband of course), a prescribed diet, and prayer.

Though this may sound comic to you or I, one must remember that it wasn’t until the early 20th century that irregular menstration was studied in any kind of scientific manner. Even Freud, who revolutionized the field of psychology, adamantly believed that morning sickness came from a woman’s hated of her husband and a desire to abort his baby, not as an evolutionary survival mechanism to protect a new mother from rotten food. The mind and body of a woman could not be separated, for that was a culturally assumed male power.

Prior to the 1870s, the medical fad known as “alienism” reigned over treatments and diagnoses. The treatment was simple: the “ill” woman would be seperated from the rest of society, where she could recover in a healthful, removed environment. Illness was defined very broadly, with symptoms ranging from bodily sores, to aches and pains, eye strain, numbness or paralysis, to nervous collapses.

Eventually, the Alienism was replaced with Somatic medicine, where a diagnosis could only be made on specific criteria. It was a step in the right direction, yes, but it still had some major flaws. For example, there weren’t that many diagnoses to chose from, and most diagnoses had such a broad range of symptoms that to categorize someone in one of the few choices was not hard. If one didn’t fit into a category, you were basically screwed.

Starting in the 1860s, Alienists fought the Somatic types in heated medical discussions and pamphlets. Somatic Medicine was to win, and in court. At the trial of the political assassin Lewis Payne the legal definition of insanity was addressed publicly for the first time in history. It was an momentous decision in American history, as well as medical, when specialist doctors from the varying camps were called in to give testimony as to the moral and mental health of the accused. Traditional doctors argued that from a moral perspective, Payne must be insane. More modern doctors argued that he couldn’t be, because he didn’t meet the rather primitive three criteria. Payne was found guilt and sentenced to hang, an event that demonstrated a clear legal need on the part of the medical industry to define precisely the ailments of their patients. Psychological diagnoses had legally been taken away from the realm of morality, and were governable instead by a necessary set of criteria and a clear definition.

Good advice.

Their first attempts to legitimately diagnose psychological conditions (remember, most ‘women’s’ conditions were ‘psychological’) were laughable, as they needed to be made without all the knowledge of biology and bichemistry, and the mountains of data the medical industry has today. Proto-psychologists (including Freud) called themselves neuresthenics, and their primary purpose was the study of what they called neuresthenia.

Neuresthenia can basically be described as, well, anything. But it was the first step in the developing field of psychology to diagnose of functioning though ‘ill’ patient, and prescribe a treatment other than a long vacation or incarceration. Financially, it was a boon. Proto-psychologists were given a blank check for treating respectable, financially well-endowed patients, enriching their pockets and attracting others to the field.

Neuresthenia, unlike other previous diagnoses of the sort, was respectable, a disease of fashion, afflicting members of the well-to-do classes. The doctors declared that it was the price the affluent “paid for American progress,” that the complexity of modern life, dense population and competition lead to a “great variety of and severity of nervous disorders of this class.”

What was this disease? The list of symptoms was two pages long, and could include everything from sweaty hands, fears, fear of fears, dryness of the skin, exhaustion, convulsions, numbness of the limbs, eye strain, female ailments or lack of decision. So, basically anything. What treatment did they use? Usually it was dependent on cultural association, based on class, gender, and age. So, vague and subjective. It remained a popular diagnosis until the end of the 19th century.

Neuresthenia was a huge step in the right direction for psychology. But, it turned every woman’s reproductive cycle into a battleground, and the fighting was fierce. Gynecologists would diagnose a woman’s ailments such as cysts or irregular cycles to a woman’s nervousness that had compromised her organs. She would usually be put under a knife, as surgery was the most common treatment.

A Doctor discovers the physical location of the female ego.

Proto-psychologists would diagnose her problem was simply being her nerves, and the threat of a progressive civilization. They criticized gynecologists as frauds, claimed that if a doctor were to “manipulate the uterus” of a woman “her mind is polluted, she is unfit for marriage.” Furthermore (Bremer), “all her thinking becomes concentrated on her womb, her egotism… assumes immense proportions” leading to divorce, failed marriages, and scores of unhappy, wronged men.

Gynecologists retorted by claiming that “women… are more nearly neutral than men, and the deprivation of their sexual glands is less felt by them… [feminine] castration has been followed by a marked change in disposition and temper, and always for the better.” (Gilliam, 1896) A woman was either sterilized or left to suffer as a sacrifice to progress.

Obviously, it was best for a woman to have as little to do as possible with the medical industry. Though I have no statistics on the successes or failures of these operations (and most of them that are available are suspect), it would be a safe guess, I think, to assume that they were not all successful. If a woman went to an aspiring and ambitious gynecologist specialist (specialist doctors could make upwards of $50,000/year in the 1890s!), he would seek to use her as an example to further his career. He may leave her alive, but missing more than she needed to lose. If she consulted a psychologist, he might tell her that her pain is from nervous exhaustion and hysteria, not from an ovarian cancer or cyst. Even worse, some doctors were notoriously lazy. Though all symptoms may point to, say, a dead fetus, there were reports of doctors intently choosing not to examine the womb out of laziness, and the subsequent bleeding from the birth killed the mother. The risks were there, indeed.

By 1890, the first fetal heart beat was heard. By 1920, neuresthenia was completely forgotten, as disorders began to get their own specific names and causes. And the cleaned-up field of gynecology had successfully made its split from that of psychology and relied on tactics other than surgical removal. On the other front the territory of Psychology had opened up with books of disorders to study and treat, leaving women’s plumbing to the specialists it had previously denounced as butchers. I think we are all much happier with the way things are today.